What sorts of values and considerations would the Christian worldview focus on in deliberating about whether or not George should opt for euthanasia?

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The practice of health care providers at all levels brings you into contact with people from a variety of faiths. This calls for knowledge and understanding of a diversity of faith expressions; for the purpose of this course, the focus will be on the Christian worldview.

Based on “Case Study: End of Life Decisions,” the Christian worldview, and the worldview questions presented in the required topic study materials you will complete an ethical analysis of George’s situation and his decision from the perspective of the Christian worldview.

Provide a 1,500-2,000-word ethical analysis while answering the following questions:

How would George interpret his suffering in light of the Christian narrative, with an emphasis on the fallenness of the world?

How would George interpret his suffering in light of the Christian narrative, with an emphasis on the hope of resurrection?

As George contemplates life with amyotrophic lateral sclerosis (ALS), how would the Christian worldview inform his view about the value of his life as a person?

What sorts of values and considerations would the Christian worldview focus on in deliberating about whether or not George should opt for euthanasia?

Given the above, what options would be morally justified in the Christian worldview for George and why?

Based on your worldview, what decision would you make if you were in George’s situation?

Remember to support your responses with the topic study materials.

Prepare this assignment according to the guidelines found in the APA Style Guide. An abstract is required.

This assignment uses a rubric.You are required to submit this assignment to LopesWrite.

1. Bioethics: A Primer for Christians

Read Chapters 6 and 12 in Bioethics: A Primer for Christians.

http://gcumedia.com/digital-resources/wm-b-eerdmans-publishing-co/2013/bioethics_a-primer-for-christians_ebook_3e.php

2. Called to Care: A Christian Worldview for Nursing

Read Chapters 10-12 in Called to Care: A Christian Worldview for Nursing.

http://gcumedia.com/digital-resources/intervarsity-press/2006/called-to-care_a-christian-worldview-for-nursing_ebook_2e.php

3. Defining Death: Medical, Legal and Ethical Issues in the Determination of Death

Read the Introduction and Chapters 1-3 of “Defining Death: Medical, Legal and Ethical Issues in the Determination of Death” by the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1984).

https://repository.library.georgetown.edu/bitstream/handle/10822/559345/defining_death.pdf?sequence=1

Rubric

Analysis of how the man would interpret his suffering in light of the Christian narrative and the fallenness of the world is clear and demonstrates a deep understanding that is skillfully supported by topic study materials. 12%

Analysis of how the man would interpret his suffering in light of the Christian narrative and the hope of resurrection is clear and demonstrates a deep understanding that is skillfully supported by topic study materials. 12%

Analysis of how the Christian worldview of the man might inform his view about the value of his life as a person with ALS is clear and demonstrates a deep understanding that is skillfully supported by topic study materials.12%

Evaluation of which values and considerations the Christian worldview focuses on when deliberating the option of euthanasia for the man is clear and demonstrates a deep understanding that is skillfully supported by topic study materials. 12%

Evaluation of which options would be justified in the Christian worldview for the man is clear and demonstrates a deep understanding that is skillfully supported by topic study materials. 12%

Reflection hypothesis of which personal choices would be make if faced with ALS based on personal worldview is clear, relevant, and insightful. 10%

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear. 7%

Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative. 8%

Writer is clearly in command of standard, written, academic English. 5%

All format elements are correct.5%

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error. 5%

What are Maria’s real and potential health risks?

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The topic this week asks you to apply what you have learned to the following case study.
As the school nurse working in a college health clinic, you see many opportunities to promote health. Maria is a 40-year-old Hispanic who is in her second year of nursing school. She complains of a 14-pound weight gain since starting school and is afraid of what this will do to both her appearance and health if the trend continues. After conducting her history, you learn that she is an excellent cook and she and her family love to eat foods that reflect their Hispanic heritage. She is married with two school-age children. She attends class a total of 15 hours per week, plus she must be present for 12 hours of labs and clinical. She maintains the household essentially by herself and does all the shopping, cooking, cleaning, and chauffeuring of the children. She states that she is lucky to get 6 hours of sleep per night, but that is okay with her. She lives 1 hour from campus and commutes each day. Using Healthy People 2020 and your text as a guide, answer the following questions.
1. What additional information would you like to gather from Maria?
2. What are Maria’s real and potential health risks?
3. Why is Maria’s culture important when obtaining the health assessment?
4. Pick one of Maria’s health risks. What would be one reasonable short-term goal for this risk?
5. What nursing interventions would you incorporate into Maria’s plan of care to assist her with meeting your chosen goal? Please provide rationale for your selections..
Your home health agency has received an order from a local hospital to evaluate and treat an elderly woman being discharged from its medical surgical unit.
Millie Gardner, an 83-year-old female patient, is being discharged home today to the care of her husband Fred (87 years old) following a 9-day hospitalization for pneumonia, dehydration, and failure to thrive. She has a history of hypertension (HTN), Type II Diabetes, and cerebral vascular accident (CVA) with left-sided weakness. Patient is alert and oriented but does have periods of forgetfulness during the overnight hours. Patient has intermittent incontinence of bowel and bladder and requires assistance with all activities of daily living (ADLs).
Medications:
• Lopressor
• Lisinopril
• Plavix
• Metformin
• Novolin R per sliding scale *NEW*
• Multivitamin
• Colace
• Zithromax *NEW*
Upon arrival you are greeted by Champ, the couple’s rambunctious miniature Doberman pinscher dog. Millie is in her wheelchair staring blankly out the window, and Fred is busy in the kitchen preparing the couple’s lunch.
• Based on the scenario above, please use the general survey process to describe the areas that you would be observing immediately upon entry to the home.
• What, if any, concerns related to Millie’s skin and nutritional status do you have?
• What nursing interventions will you include in the plan of care to address these concerns?
• What teaching strategies will you use to educate Millie and Fred on the new medications?
• Using the SBAR, please include the information that you will communicate to the physician’s office at the completion of the visit.

Discussion 3
Randy Adams is a 38-year-old male patient of Dr. Joseph Reynolds who was admitted yesterday morning for 24-hour observation for mild concussion following a motor vehicle accident. Randy lost consciousness during the accident and was very confused when he arrived in the ER after EMS transport. He is an Iraq war veteran and he seemed to think after the accident that this all happened in Iraq. Dr. Reynolds is concerned that Randy has some residual problems from a couple of explosive incidents that occurred while he was in Iraq. The physician is unsure whether Randy’s current symptoms are from the car accident or from prior injuries so he has referred him for consultations to both a neurologist and to a behavioral health specialist.
Based on the above please discuss the following.
1. Pathophysiology of concussive injuries and treatment
2. Neurological assessment tools used in your current practice setting (if not presently working, please describe one used during prior employment or schooling)
3. Current best practices associated with post-traumatic stress disorder (PTSD)
4. Nursing interventions you would include in this patient’s plan of care

Esther Jackson is a 56-year-old black female who is 1-day post-op following a left radical mastectomy. During morning rounds, the off-going nurse shares with you during bedside report that the patient has been experiencing increased discomfort in her back throughout the night and has required frequent help with repositioning. She states that the patient was medicated for pain approximately 2 hours ago but is voicing little relief and states that you might want to mention that to the doctor when he rounds later this morning. With the patient appearing to be in no visible distress, you proceed on to the next patient’s room for report.
Approximately 1 hour later, you return to Ms. Jackson’s room with her morning pills and find her slumped over the bedside stand in tears. The patient states, “I don’t know what is wrong, I don’t feel right. My back hurts and I’m just so tired. What is wrong with me?” The patient refuses to take her medications at this time stating that she is starting to feel sick to her stomach.
Just then the nursing assistant comes into the patient’s room to record Ms. Jackson’s vital signs, you take this opportunity to quickly research the patient’s medication record to determine if she has a medication ordered for nausea. Upon return, the nursing assistant hands you the following vital signs: T 37, R 18, and BP 132/54, but states she couldn’t get the patient’s pulse because “it is all over the place.”
Please address the following questions related to the scenario.
1. What do you suspect is the cause of the patient’s symptoms?
2. Describe the course of action that you will take to confirm this suspicion and prevent further decline.
3. What further assessments, lab values, and tests will likely be ordered for this patient and how often? If testing is to be completed more than once, please explain the rationale for doing so.
4. While you are caring for this patient, how will you ensure that the needs of your other patients are being met?

Describe one activity centered on an important nutrition concept for families to explore

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As educators, we want to encourage active participation among the diverse and busy families we work with in ways that consider their various structures, needs, lifestyles, and schedules. We teach children about health, wellness, nutrition, and safety in school; however, we want to offer families support for continuing this education in the home. Thematic backpacks, which are sent home with children for a week throughout the year, either on a rotating schedule or a sign-out system, is one idea for how to engage families at home. Thematic backpacks include materials, parent information, games, manipulatives, and other resources all centered on a teacher-created thematic plan to explore the contents in a fun and engaging way at home with the family. Children love these, and family members can be involved in learning at home when it is convenient for them.
Create a plan for the development of a health, wellness, nutrition, and safety unit backpack that you can send home with your families. For this assignment, only the written plan is required; however, you are encouraged to create this resource as you develop the plan. The purpose of the backpack is to encourage families to explore the areas of health, wellness, nutrition, and safety at home.
The requirements for your written plan are as follows:
1. Introduction letter (no longer than one page):
o Explain the purpose of the backpack. This should be written in a family-friendly form and be visually appealing. You may wish to use colored font, graphics, or pictures to set the tone for a fun and engaging experience.
2. Health:
o Describe one idea, activity, or game centered on an important health concept for families to explore. For example, you may include a sorting game that has pictures or text of sick/hurt children. Families can sort into two piles: “Okay to go to school” or “Stay home.” Example pictures/text could include runny nose, fever, scraped knee, sneezing, band-aid, etc. Try to think about creative fun ideas that allow families to explore the topic and materials.
3. Wellness:
o Describe one idea, activity, or game centered on an important wellness concept for families to explore. For example, you may include ideas for a family exercise night or an outdoor scavenger hunt.
4. Nutrition:
o Describe one idea, activity, or game centered on an important nutrition concept for families to explore. For example, you may include a healthy recipe book, a recipe to make a healthy snack together, or a grocery store game.
5. Safety:
o Describe one idea, activity, or game centered on an important safety concept for families to explore. For example, you might include a composition notebook in the backpack and encourage children and families to draw a picture of something that they do safely or draw a picture of a safety practice they follow at home.

Explain the importance of continuing education regarding organizational change

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The health care industry, like other industries, is a very competitive environment. As organizational behavior within health care companies evolves, it will be even more important to consider the future use of learning about/applying concepts of organizational behavior and the need for continuing education.

After a productive year with the medical waste management company, Justin has now been tasked with implementing a company-wide policy change to require continuing education. Each employee will now be required to complete 2 hours of continuing education each year.

Justin’s supervisor has asked for an analysis and plan for the implementation of this company-wide change. This analysis will be presented to company leadership as a tool for understanding and implementing this change.

Answer the following prompts as your analysis of the change process identified above. Write your answers beneath each prompt.

Explain the importance of continuing education regarding organizational change (100 to 175 words).

Explain the impact this policy change may have on the organizational behavior and organizational culture of the company (100 to 175 words).

Explain barriers to change and how to address the barriers (100 to 175 words).

Explain how this change may affect individual job performance and job satisfaction (100 to 175 words).

Explain a motivational strategy that might be used for implementation (100 to 175 words).

Explain how teams or groups could be used to implement this policy change. Include a review of two approaches managers can use to build team performance and two organizational barriers to team effectiveness (100 to 175 words).

Identify communication methods to be used to support this policy change implementation (45 to 90 words).

Cite 2 reputable references. Reputable references include trade or industry publications; government or agency websites; scholarly works; your textbook, Organizational Behavior, Theory, and Design in Health Care (2nd ed.); or other sources of similar quality.

Format your references according to APA guidelines.

Explain the accountability of the nurse leader for decisions that affect health care delivery and patient outcomes

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Nursing within an organization is a critical component of health care delivery and is an essential ingredient in patient outcomes (Kelly & Tazbir, 2014). The concern for quality care that flows from evidence-based practice generates a desired outcome. Without these factors, a nurse cannot be an effective leader. It is important to lead not only from this position but from knowledge and expertise.

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

Competency 2: Explain the accountability of the nurse leader for decisions that affect health care delivery and patient outcomes.

(IMPORTANT) -Describe accountability tools and procedures used to measure effectiveness.

Competency 3: Apply management strategies and best practices for health care finance, human resources, and materials allocation decisions to improve health care delivery and patient outcomes.

(IMPORTANT) -Develop an evidence-based plan for health care delivery.

Competency 4: Apply professional standards of moral, ethical, and legal conduct in professional practice.

(IMPORTANT) -Apply professional and legal standards in support of a care plan.

Competency 5: Communicate in manner that is consistent with the expectations of a nursing professional.

(IMPORTANT) -Write content clearly and logically, with correct use of grammar, punctuation, mechanics, and current APA style.

Preparation

Refer to the Capella library and the Internet for supplemental resources to help you complete this assessment.

Instructions

Deliverable: Develop an evidence-based plan for health care delivery.

Scenario:

The hospital where you work has an issue with increased readmissions within 30 days of discharge. After examining the core measures, it was found that heart failure was the most common core measure disease process experiencing the highest rate of readmissions. The leadership team has given your team the charge of developing a nurse-run outpatient heart failure clinic. The purpose of this clinic is to ensure that discharge education is presented to the patient in an orderly, consistent manner and complies with evidence-based practice protocols. Since these patients may be discharged from a variety of areas in the facility, having the heart failure clinic staff take ownership of the process will improve both consistency and compliance. There are cardiologists that interact with the staff and patients, but the day-to-day operations of the clinic are designed and supported by the nurses as they interact with appropriate members of the other health care team disciplines promoting the best care for the heart failure patients.

As a member of the nurse team, you have been asked to develop one component of the clinic.

The hospital leadership established these objectives for the clinic services:

Evaluate and maximize proper medication therapy.

Conduct regular diet, exercise, and stress management classes for the patients.

Monitor physiological indicators for the patients (lab work, weights, vital signs, ECGs).

Provide a case management system for patients in the program post-discharge.

The overall goals for the heart failure clinic are to:

Enroll greater than 90 percent of the patients with a primary or secondary diagnosis of HF prior to discharge.

Facilitate discharge planning to achieve 100 percent compliance with patient education prior to discharge (discharge planning).

Decrease readmission rates in this population by 5 percent over the next year.

The leadership team has asked you to provide them with an evidence-based plan for one of the components of the clinic. You may use any combination of documents (for example, a spreadsheet or a table) in addition to explanatory information to convey information clearly and succinctly.

Develop one: an Orientation Course Plan, a Discharge Education Plan, or a Care Coordination Plan.

An Orientation Course Plan:

Develop an evidence-based plan for health care delivery.

Include a comprehensive schedule of topics, objectives, key points, and patient resources for the orientation course.

What are the components of an evidence-based education plan?

How will you know that patients will understand what to do?

What modalities will you use to deliver information?

How will you adapt the plan to meet the needs of patients from diverse cultural and language backgrounds?

Identify specialized and supplementary material needs.

Apply professional and legal standards in support of a care plan.

Explain the alignment to the most recent Heart Failure Guidelines and specific professional standards.

Describe the accountability tools and procedures used to measure effectiveness.

How will you know if the patient education plan is successful?

What are the indicators of success or effectiveness?

A Discharge Education Plan:

Develop an evidence-based plan for health care delivery.

Develop a discharge plan with objectives and resources, and tools for patients to monitor their progress.

How will you know that patients understand what to do?

What modalities will you use to deliver information?

How will you adapt the plan to meet the needs of patients from diverse cultural and language backgrounds?

Apply professional and legal standards in support of a care plan.

Explain the alignment to the most recent Heart Failure Guidelines and specific professional standards.

Describe accountability tools and procedures used to measure effectiveness.

How will you know if the discharge plan is successful?

What are the indicators of success or effectiveness?

Care Coordination Plan:

Develop an evidence-based plan for health care delivery.

Develop a procedure for coordinating services.

Consider the needs of “outliers.” For example, someone with lung disease may need extra resources.

Who should be on the team?

When would the team be activated?

How would it be activated?

What is the time frame required to coordinate services?

How would the intervention plan be monitored for effectiveness?

Apply professional standards in support of a care plan.

Explain the alignment to the most recent heart failure guidelines and specific professional standards.

Describe accountability tools and procedures used to measure effectiveness.

How will you know if the care coordination plan is successful?

What are the indicators of success or effectiveness?

How will information be collected or communicated?

Compare and contrast The Matrix with the readings from Plato and Descartes

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In this unit, we have been discussing how we “know.” The modern American philosopher, Hilary Putnam, popularized a well-known thought experiment highlighting the problem of skepticism and our knowledge of reality. To understand Putnam’s experiment, we need to consider how we normally obtain knowledge of reality. Our knowledge of reality usually begins with sensory input. While each of our five senses perceives the world according to their individual means, we will use seeing as an example. Light is reflected off of objects and enters through our eyes, which focus an image of these objects to the back of our eyeball, where it hits our optic nerve. Our nerve transforms this image into electrical/neural impulses that travel through the optic nerve up to where it is plugged into the brain. The brain then processes these impulses where they are transformed into an image in our mind. What our minds experience is an image of the outside world, similar to how a television projects an image captured by a television camera.

In Putnam’s thought experiment, you imagine that your brain has been severed from the nerves connecting it to your senses (eyes, ears, nose, etc.) and has been removed from your skull and placed in a vat filled with the nutritional fluid necessary to keep your brain alive and functioning. Electrical wires have been spliced into your sensory nerves that are connected to the sensory inputs in your brain. The other ends of these wires are connected to the outputs of a giant super computer. A man sits at the keyboard of this super computer, inputting data. This data is transformed into electrical/neural impulses that travel through the spliced wire/sensory nerves and into your brain. The brain processes this information as if it were from your senses. Hence, you have whatever image the man at the keyboard wants you to have. Suppose he inputs data that you are sitting in a café in France, drinking an espresso. He includes all the usual sensory data, including the smell and taste of the coffee, the hardness of the chair and table, the cool breeze blowing by, the sounds of the traffic, and the view of the Eiffel Tower. You experience all of this exactly as if you are really there. In such a situation, you would have no idea that you (or at least your brain) are actually sitting in some vat in some laboratory.

In 1999, Putnam’s thought experiment became the basis of a megahit movie, The Matrix. However, Putnam was not the first to suggest that there may be a problem with perceiving and knowing reality. A number of philosophers have wrestled with this problem. This brings us to your assignment, described below.

In Module/Week 5’s Reading & Study folder, there are 3 short readings. Your assignment is to read them and then write an essay of at least 600 words (in current MLA, APA, or Turabian format) addressing some of the questions listed below (in the “Questions to Consider” section). You must address the first question; then, choose 1 of the other questions to address also.

While you are free to quote from sources, quotations will not count towards the minimum word count. Plagiarism of any kind will result in a 0 for the assignment and may result in being dropped from the course.

A note about the readings: The first reading is a synopsis of The Matrix. If you have seen the movie, this will function as a review for you. If you have not seen the movie, you may choose to do so. However, you should know that the movie is rated R for language and violence. It is not necessary to view the movie to fulfill the assignment, as the synopsis is enough to consider the questions. The second reading comes from Plato’s classic work, The Republic. It is in the form of a dialogue between Socrates and Glaucon, a brother of Plato, and contains the famous cave allegory. The third and final reading is a section from Meditation I, from Meditations on First Philosophy by Rene Descartes, who offers some reasons to doubt his senses.

Questions to Consider

1. Compare and contrast The Matrix with the readings from Plato and Descartes. What are some similarities and differences?

2. Can we prove that the world we are experiencing is real? How do we know we are not dreaming, living in a Platonic cave, or trapped in some sort of matrix?

3. At the end of the cave allegory, Socrates implies that most men would want to escape the cave and see reality as it really is. However, in his betrayal of Morpheus, Cypher implies that it is better to live in the artificial world of the Matrix. Which is better: the harshness of reality, or the “ignorance is bliss” of illusion? Defend your answer.

4. Since much of our knowledge is based on sensory experience, and since our senses are imperfect and can be deceived, can we ever be certain that our beliefs are true? Defend or explain your answer.

Is it proper procedure for Sarah to be applying for this position given that she has not yet completed her medical assisting program?

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Part A: Marge Riley, an overweight 50-year-old woman with a history of abdominal pain, has been scheduled for a lower GI series on Monday morning. She states she has board meetings every Monday morning at which breakfast is served and that she will come in for her x-rays after the meeting is over. Marge indicates that she does not understand why she needs these procedures.

Provide detailed answers for each of the following questions. Your response should be at least 150 words in length.

• What, if anything, would you tell the patient regarding her need for these procedures?

• How would you describe these procedures to the patient?

• What combination of teaching methods would you use to explain the procedures?

• You are still concerned, after explaining everything to Marge, that she will not follow the instructions. What do you do?

Part B: Jenny Watmore, a medical assistant working in Dr. Cory’s orthopedic practice, has been asked to assist Mr. Ivy from the wheelchair onto the examination table. Mr. Ivy, who is 70 years old, is weakened on the left side of his body from a cerebrovascular accident (CVA). He weighs 200 pounds and is reluctant to provide much help to Jenny when she has to transfer him from the wheelchair to the examination table.

Provide detailed answers for each of the following questions. Your response should be at least 150 words in length.

• How can Jenny get Mr. Ivy to help her assist him?

• Describe the body mechanics that Jenny should use to assist Mr. Ivy.

• What patient education does Mr. Ivy need?

• What documentation should Jenny provide on Mr. Ivy’s record?

Part C: Dr. Waring has a solo practice. When she is on vacation, she arranges for Dr. Dumphey to cover her patients. Dr. Dumphey’s medical assistant, Theresa, has just received a call from a patient of Dr. Waring. The patient is an elderly woman, with multiple medical problems, who is possibly having a reaction to a medication that Dr. Waring prescribed two days ago for bronchitis. Her symptoms include nausea, upset stomach, dizziness, headache, rash on her chest, and extreme exhaustion. Theresa senses that the patient may be exhibiting some disorientation to time and place, because it is difficult to elicit consistent responses from her regarding her medications. The patient reports to Theresa that the newest medication she has been taking is Biaxin. The other medications she takes include Prinivil, Cardizem CD, Premarin, Prilosec, Robaxin, Zocor, Ambien, Prozac, Fosamax, Seldane, and aspirin. The patient does not know the dosage of any of these medications but is willing to “open up her bag of medicine” and read each prescription label to Theresa.

Provide detailed answers for each of the following questions. Your response should at least 200 words in length.
• Does Theresa have an obligation, as Dr. Dumphey’s medical assistant, to handle this situation with this patient, or should Dr. Waring simply be notified?

• Is this an emergency situation or potential emergency situation and, if so, what should Theresa do immediately?

• Because the patient seems disoriented, should Theresa even trust what the patient is reporting?

• Should Theresa have the patient read the label of each of her medications?
Part D: Stacy Friedlander is the lead medical assistant in an ophthalmology practice of ten physicians. The eye clinic has patients, literally, from all over the world. Several of the physicians are leaders in their specific area of ophthalmology, such as Dr. Keeler, who specializes in retinal diseases.

Today, Stacy is going to interview a potential new employee, Sarah Banks. Sarah is currently finishing a CAAHEP-approved medical-assisting program at a local college and is searching for full-time employment. She has some on-the-job experience dating back to when she was an after-school receptionist for a general practitioner, but that was more than ten years ago.

The clinic tends to hire medical assistants who are certified, experienced, and very capable of dealing with patients from different age groups, races, and cultures. However, Sarah is being considered for the position because, first of all, her father is a personal friend of Dr. Keeler and, second, qualified medical assistants are difficult to find because of the high demand.
Provide detailed answers for each of the following questions. Your response should at least 150 words in length.

• What should Stacy do to prepare for the interview with Sarah?

• Considering that the practice is limited to ophthalmology, would any special requirements be warranted in a medical assistant who was going to work in this area?

• Considering that the clinic’s patient population is mixed by age and race, would any special requirements in a medical assistant be warranted in this case?

• Is it proper procedure for Sarah to be applying for this position given that she has not yet completed her medical assisting program?

• Should Stacy, given the circumstances, invest a lot of time in interviewing Sarah? Why or why not?

• Should Sarah’s ten-year-old job experience be factored into Stacy’s decision to hire Sarah or not?

• If Stacy decides not to hire Sarah, does Stacy need to personally contact the reference and thank him anyway, given that he is a friend of Dr. Keeler?

Does movement or rest alleviate symptoms?

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Abdominal bloating can be the result of many different ailments. Several questions can help the provider find the cause of the symptoms. The first question you can ask is when did she notice the bloating? This will help give some direction of how long the complaint has been going on and what may have caused it. If there is any associated pain and if so when was the onset, duration, frequency and relationship can help eliminate causes and questions such as: Does it get better or worse when you eat certain foods? Does movement or rest alleviate symptoms? Where is the bloating feeling exactly? Location can provide clue regarding the mechanism of the bloating. Has she has had any nausea or vomiting? Although the patient has passed gas, this writer would ask when was the last bowel movement because the patient could also be constipated.

The physical examinations should include vitals and assessment of the abdomen (inspection, auscultation, percussion, and palpation). Included in the physical exam of this visit will be an oral exam making sure to thoroughly exam the teeth and the mucosa for sores, noting the teeth and mucosal colors. A musculoskeletal exam would also be performed noting any muscle weakness, fatigue, joint pain, numbness or tingling. Generalized skin exam noting skin color, lesions, or rashes. Neurological examination for headaches, migraines, or confusion. Psychosocial for any anxiety or depression. Social habits for any drug or alcohol abuse. There are tons of differential diagnoses that comes along with abdominal pain since this area can reciprocate pain from other areas in the body. Differential diagnosis can include constipation, bowel obstruction, Chrons, food allergies, enteritis, irritable bowel syndrome or celiac disease.

Test should be ordered and performed along the history and physical to help assist diagnosing. A complete blood count, serum chemistries, liver function tests, urinalysis, pregnancy test, and abdominal films will help determine the acuity of the problem (Dunphy, Winland-Brown, Porter, & Thomas, 2015). Antibody levels that are elevated indicate an immune reaction to gluten. Genetic testing could also be an option, and might include antigens that are used to rule out celiac (Bascunan, Vespa & Araya, 2017). A kidney, utter, and bladder (KUB) x-ray may also be ordered to asses organs, structures, causes of the bloating. Further testing may include endoscopes and possible biopsy to rule out other gastrointestinal (GI) conditions.

The main thing about managing any disease is diet, education, and pharmacological and nonpharmacological interventions. This is most true for IBS. If gluten is the issue, the patient must have a strict diet that includes avoiding wheat, barley, rye, malt, and more. Education is key. In doing so, this promotes decreased inflammation and intestinal healing (Mayo Clinic, 2018). Crohn’s disease can also be treated with latter. It is mostly treated with immunosuppressant drugs. Medical follow-up is also necessary to ensure a healthy body response to the new changes. If unresponsive to this surgical interventions are required.

What should be the goal of nutritional therapy based on assessment data and the patient’s history?

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Mr. W is a 25-year-old male who was in a drug rehabilitation program last year. He has been admitted to the hospital with a history of weight loss, weakness, and intractable diarrhea. His height is 70 inches and his weight has dropped from 180 lbs. to 110 lbs. He is also suffering from fever and night sweats. Physical examination reveals swollen lymph glands, tongue lesions of herpes simplex and ulcers in the perianal region. Further tests indicated depressed T-cell levels and the presence of Pneumocystis carinii. He was tested for HIV infection and the blood test for HIV infection antibodies was positive.
While in the hospital he developed several other symptoms: anorexia, fever, fatigue, nausea, vomiting, watery diarrhea, and fecal incontinence. His temperature was 103°F (39.8°C) and was treated with antibiotics to which he did not respond. The amount of diarrhea increased markedly, necessitating intravenous hydration. He developed esophageal candiasis and a duodenal infection.
The patient did not tolerate a soft diet or nutritional supplements, continued to lose weight, and had severe anorexia, abdominal cramping, and bloating. Nutritional assessment was deficient in all aspects, showing a decreased BMI, decreased muscle mass, and depleted total protein and serum albumin.
1. In which stage of HIV infection would you categorize Mr. W?
2. Name and describe the major clinical complications in the final stage of AIDS and explain how these complications profoundly compromise a patient’s nutritional status.
3. What should be the goal of nutritional therapy based on assessment data and the patient’s history?

NS335
Unit 6 Assignment
4. Utilize your critical thinking skills to determine the most appropriate route of feeding to administer nutrition support. Defend your choice with evidence from the patient description and the knowledge you have gained regarding alternative feeding routes.
5. Working with patients who have HIV can include a number of sensitive issues, including patient confidentiality, integrity and ethical issues, and social responsibility. Explain how you would deal with these issues as you attend to Mr. W.
6. List several nutritional supplements that might be used to alleviate some of Mr. W’s symptoms and increase his caloric intake when he is able to tolerate a diet again.
7. Write a Nutrition Care Plan/Chart note on the HIV patient that addresses the patient’s current clinical situation. Write this note as though you were a nutrition professional caring for this patient in a hospital setting. Please refer to Table 11-3 and 11-4 in your textbook for information on the ADIME chart note process. Requirements Paper format: Answer questions numbers 1–5 in a 2–3 page paper using APA format and citation guidelines. Include a title page, introduction, body, conclusion, and reference page. Include number 6, the Nutrition Care Plan/ Chart note, as an appendix. Be aware that the title page, reference page, and appendix/chart note DO NOT count towards the 2–3 page minimum.
Please organize your paper in the following paragraph format. Please see KUs Writing Center for more information regarding essay and paragraph format.
Section 1: Introductory paragraph (incorporate your answer to question 1)
Section 2: Body paragraph(s) (incorporate your answer to question 2)
Section 3: Body paragraph(s) (incorporate your answer to question 3)
Section 4: Body paragraph(s) (incorporate your answer to questions 4-5)
Section 5: Concluding paragraph (incorporate your answer to question 6)
Appendix: Nutrition Care Plan/Chart note (question 7) References: Include a minimum of 4 quality references. Your textbook may count towards this requirement. You can use reputable websites or other textbooks/ scientific or medical journal articles. Please use APA style citations within the paper itself and also on the reference page.

Discuss the role of a nurse in promoting optimal health outcomes as it pertains to your allocated scenario

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The aim of this assessment piece is to provide you with the opportunity to demonstrate application of knowledge and skills in the provision of written, client-specific optimal nutrition status and physical activity advice at an individual level in the context of nursing/ midwifery practice.
Word Count 2500 words
You must include a word count (including in-text referencing but excluding the reference list or any Appendices) at the end of your assignment. Word count more than 10% below or above that prescribed will be penalised by 10% deduction from the total available marks.

Task Description
Following the education session (assessment task 2) an audience member approaches you to discuss diet and healthy lifestyle that is more specific to their individual circumstance. Continue using your assigned scenario from assessment task 2. Refer to the following page for more information relating to your scenario that has been obtained from the audience member. Prepare a written response to the subheadings and dot points listed below.
Introduction
• Include an accurate statement of the topic that highlights the significance of the health issue identified in the scenario; and provide an accurate overview of the content of your written response.
Anthropometric measurements:
• Identify and critically discuss the anthropometric measurements used for assessment of body composition.
• Identify evidence-based lifestyle recommendations as they relate to your scenario. Care Plan (person centered approach)
• Provide detailed, evidence-based recommendations for both optimal nutrition modification and physical activity. Recommendations should be specifically tailored, practical and sustainable in the long term.
• Discuss the role of a nurse in promoting optimal health outcomes as it pertains to your allocated scenario. Describe strategies that the nurse/midwife could use to support and promote client self- management of the identified nutritional and physical activity recommendations. When describing relevant self-management strategies, the identification of barriers and solutions and input from a multidisciplinary team (MDT) referral system should be considered.
Conclusion
• Include an accurate summary of the recommendations without introducing new information. References
• Integrate a range of high quality, relevant and current literature sources and guidelines throughout your report and use JCU APA 6th edition (2015) for both in-text referencing and the reference list.

Case study
Scenario 4 – A group of middle aged aborigional men.
You are a nurse working at the local Aboriginal Medical Service in an urban area. The Indigenous health worker Frank has organised a 12 week healthy lifestyle program for his middle aged (45- 55 years) overweight male clients. Frank has asked you to present the session on healthy eating.

One of the participants named Frank approaches you in the afternoon tea break following your education session. Frank is a 45 year old Aboriginal man originally from Normanton, a small town in northwest Queensland. He tells you that many of his family members have diabetes and some have even died from cardiovascular disease. Frank has a young family and wants to ensure he is around to see his kids grow up, but he feels that it’s only a matter of time before he is diagnosed with diabetes because it runs in his family.
He says ‘I know my belly is big, probably bigger than it should be, but everyone in my family is big, I guess we are just big boned’. Frank says during the week he enjoys having a hamburger and chips from the local take away shop. He works for a local transport company in the office, so walking to the shop for his lunch allows him to stretch his legs and get up from the computer.